Honor walks are ceremonies that purportedly honor organ donors as they make their final journey from the ICU to the OR. In this paper, we draw on Ronald Grimes’ work in ritual studies to examine honor walks as ceremonial rituals that display medico-technological power in a symbolic social drama (Grimes, 1982). We argue that while honor walks claim to honor organ donors, ceremonies cannot primarily honor donors, but can only honor donation itself. Honor walks promote the quasi-religious idea of donation (...) as a “good death,” and mask the ambiguity and discomfort inherent in organ donation to promote greater acceptance by the medical community. While some goods may be achieved through honor walks, particularly for donor families, it is still important to examine the negative work done by this practice. (shrink)

In recent years, increasingly advanced artificial intelligence (AI), and in particular machine learning, has shown great promise as a tool in various healthcare contexts. Yet as machine learning in medicine has become more useful and more widely adopted, concerns have arisen about the “black-box” nature of some of these AI models, or the inability to understand—and explain—the inner workings of the technology. Some critics argue that AI algorithms must be explainable to be responsibly used in the clinical encounter, while supporters (...) of AI dismiss the importance of explainability and instead highlight the many benefits the application of this technology could have for medicine. However, this dichotomy fails to consider the particular ways in which machine learning technologies mediate relations in the clinical encounter, and in doing so, makes explainability more of a problem than it actually is. We argue that postphenomenology is a highly useful theoretical lens through which to examine black-box AI, because it helps us better understand the particular mediating effects this type of technology brings to clinical encounters and moves beyond the explainability stalemate. Using a postphenomenological approach, we argue that explainability is more of a concern for physicians than it is for patients, and that a lack of explainability does not introduce a novel concern to the physician–patient encounter. Explainability is just one feature of technological mediation and need not be the central concern on which the use of black-box AI hinges. (shrink)

Objectives To characterize the prevalence and content of pediatric triage policies.Methods We surveyed and solicited policies from U.S. hospitals with pediatric intensive care units. Policies were analyzed using qualitative methods and coded by 2 investigators.Results Thirty-four of 120 institutions (28%) responded. Twenty-five (74%) were freestanding children’s hospitals and 9 (26%) were hospitals within a hospital. Nine (26%) had approved policies, 9 (26%) had draft policies, 5 (14%) were developing policies, and 7 (20%) did not have policies. Nineteen (68%) institutions shared (...) their approved or draft policy. Eight (42%) of those policies included neonates. The polices identified 0 to 5 (median 2) factors to prioritize patients. The most common factors were short- (17, 90%) and long- (14, 74%) term predicted mortality. Pediatric scoring systems included Pediatric Logistic Organ Dysfunction-2 (12, 63%) and Score for Neonatal Acute Physiology and Perinatal Extensions-II (4, 21%). Thirteen (68%) policies described a formal algorithm. The most common tiebreakers were random/lottery (10, 71%) and life cycles (9, 64%). The majority (15, 79%) of policies specified the roles of triage team members and 13 (68%) precluded those participating in patient care from making triage decisions.Conclusions While many institutions still do not have pediatric triage policies, there appears to be a trend among those with policies to utilize a formal algorithm that focuses on short- and long-term predicted mortality and that incorporates age-appropriate scoring systems. Additional work is needed to expand access to pediatric-specific policies, to validate scoring systems, and to address health disparities. (shrink)

Medical trainees should learn from the actions of Nazi physicians to inform a more just contemporary practice by examining the subtle assumptions, or moral orientations, that led to such heinous actions. One important moral orientation that still informs contemporary medical practice is the moral orientation of elimination in response to suffering patients. We propose that the moral orientation of presence, described by theologian Stanley Hauerwas, provides a more fitting response to suffering patients, in spite of the significant barriers to enacting (...) such a moral orientation for contemporary trainees. (shrink)

Three ethical conflicts in particular are paradigmatic of what we define as “clerkship ethics.” First, a distinction that differentiates the clerkship student from the practicing physician involves the student’s principal role as a learner. The clerkship student must skillfully balance her commitment to her own education against her commitment to patient care in a fashion that may compromise patient care. While the practicing physician can often resolve the tension between these two goods when they come into conflict, the clerkship student (...) is left with a more ambiguous set of choices. Second, evaluative scrutiny during clinical clerkships often forces medical students to balance doing what is morally fitting against the perceived expectations of the medical teams in which they work. Third and finally, a deeply entrenched culture of medical hierarchy presents a particular challenge to innovation and improvement in ethics education during the clerkship years. Students regard faculty as exemplars, but are not provided with the tools to assess when technical medical competence is not matched by moral competence; moreover, these faculty are unlikely to have experienced the ethics education in which students are asked to demonstrate mastery. (shrink)

Loneliness in medicine is a serious problem not just for patients, for whom illness is intrinsically isolating, but also for physicians in the contemporary condition of medicine. We explore this problem by investigating the ideal physician-patient relationship, whose analogy with friendship has held enduring normative appeal. Drawing from Talbot Brewer and Nir Ben-Moshe, we argue that this appeal lies in a dynamic form of companionship incompatible with static models of friendship-like physician-patient relationships: a mutual refinement of embodied virtue that draws (...) both persons together. The ideal physician-patient relationship has a dialectical character that fosters each member's improvement of phenomenologically recognizing and embodying moral virtues. A key component of this dynamic is a commitment to the common goal of the patient's health, realized through joint interactivities and conversations over time. The physician's presence to the patient's suffering—understood best as an alienating phenomenological condition for the patient—orients and discloses possibilities for virtuous caregiving by structuring the meanings of the goals, conversations, and joint narrative constitutive of their relationship. Presence to suffering, paradoxically, is perhaps an important prerequisite for this dynamic partnership. These activities dialectically build an interpretive horizon of understanding through which moral goods and character refinement—in and for the other—may become revealed for both persons in their shared being-in-the-world. This analysis of suffering, mood, and revealing of (possible) moral goods has implications for addressing the modern problem of loneliness for patients and physicians, who are increasingly inhibited from building flourishing relationships with each other. (shrink)

Background: There are numerous benefits to ethics consultation services, but little is known about the reasons different professionals may or may not request an ethics consultation. Inter-professional differences in the perceived utility of ethics consultation have not previously been studied.Methods: To understand profession-specific perceived benefits of ethics consultation, we surveyed all employees at an urban tertiary children’s hospital about their use of ethics committee services (n = 842).Results: Our findings suggest that nurses and physicians find ethics consultations useful for different (...) reasons; physicians were more likely to report normative benefits, while nurses were more likely to report communicative and relational benefits.Conclusions: These findings support an open model of ethics consultation and may also help ethics committees to better understand consultation requests and remain attuned to the needs of various professional groups. (shrink)

For Plato and Aristotle, arete (traditionally translated as "virtue") was the essential object of human admiration and striving, and even the key to happiness. Their work continues to inspire reflection on fundamental questions of ethics and politics today, as the fourteen new essays collected here demonstrate. -/- Contributors: Lidia Palumbo, Eva Anagnostou-Laoutides, Ryan M. Brown, Jay R. Elliott, Guilherme Domingues da Motta, Federico Casella, Jonathan A. Buttaci, George Harvey, Mark Ralkowski, Gary S. Beck, Paula Gottlieb, Giulio di Basilio, Audrey L. (...) Anton, and Elena Bartolini. (shrink)

Scholars have long debated how exactly Aristotle thinks that agents acquire the distinctive archai (“principles” or “starting‐points”) that govern their practical reasoning. The debate has traditionally been dominated by anti‐intellectualists, who hold that for Aristotle all agents acquire their archai solely through a process of habituation in the nonrational soul. Their traditional opponents, the intellectualists, focus their argument on the case of the virtuous person, arguing that in Aristotle’s view virtuous agents acquire their archai through a process of reasoning. I (...) intervene in this debate in two main ways: first, I press a heretofore underappreciated objection against anti‐intellectualism, that it is inconsistent with Aristotle’s account of akrasia; and second, I urge that all sides in the debate would benefit from more sustained attention to Aristotle’s nonvirtuous character types. In the final section, I suggest that proper consideration of the full breadth of Aristotle’s account of character points in the direction of a new approach that I call “character pluralism,” according to which Aristotle’s moral psychology does not involve a single conception of psychic structure or moral development that is equally applicable to all character types. (shrink)

Did Plato see something that Aristotle missed? According to a familiar narrative, Plato regarded literature as dangerous to the aims of philosophy, and he accordingly exiled the poets from his ideal republic. By contrast, Aristotle is supposed to have reconciled literature and philosophy, not only through his appreciative account of epic and tragedy in the Poetics but also through his invocations of literary examples at crucial junctures elsewhere in his corpus, for example his use of the Trojan legend of Priam (...) in the Nicomachean Ethics. (shrink)

This paper is a response to Dickemann’s review ofPedophilia: Biosocial Dimensions. Her main criticism of the book is its inappropriate application of ethology to human sexology and its natural variations. She proposes instead the superiority of the “social constructionist” perspective. The “Phylogenetic Fallacy” of which her review speaks results from her erroneously having attributed ethological arguments about the phylogeny of coordinated motor patterns and sensory releasing stimuli to higher levels of behavioral-ecological strategies to which such arguments were never applied. Because (...) no convincingly adaptive function of human pedophilia could be found at this higher level, as a working hypothesis, variant erotic age and gender orientations were both tentatively conceptualized as by-products of Darwinian natural selection for heterosexual “adultophilia.” The social and political implications of this perspective, when compared to social constructionism, are discussed. (shrink)

For the past 500 years, to varying degrees, the processes of religious secularization have been occurring in what today are the wealthy, highly educated, industrialized nations of the world. They are causing organized religion, as a social institution, to go from being a very important influence on the lives of people and the nations in which they live to being a smaller influence, or almost no influence at all. Various disciplines from theology to psychology to sociology have tried to explain (...) secularization, each discipline contributing something unique. One discipline that has not contributed has been biology. From a biological perspective, based on observation and reasoning, at least one of the ultimate functions of the physical forms associated with religion appear to be that of in-group marker for a breeding population, which, as will be shown, is how all religions start. Religions structure larger human populations into smaller “clusters” that are separate in-group breeding populations. The clustering into smaller in-group breeding populations prevents the spread of contagious diseases and creates inter-group competition and intra-group cooperation, both of which have contributed to human eusociality, a very rare type of social organization that will be explained. As the physical forms of religion are losing this in-group-marker function of clustering populations with modernity, a general biological principle comes into play, which is “form follows function, and as function wanes, so does form.” When applied to religion, “form” means the physical components by which all religions are built. The specific meaning of “physical,” as used here, will be explained in the article. This biological perspective, which is counter-intuitive and can generate testable hypotheses, should complement, not compete, with perspectives from other disciplines. Physical forms in biology can and often do have more than one function, so the same form with a biological function can also have psychological and theological functions. The physical forms of religion are its objects of natural (genetic and cultural) selection. As socio-economic modernity spreads through the world, the evolutionary biological trajectory suggests that religion, as a social institution, will eventually become extinct. (shrink)

In Nicomachean Ethics III.5, Aristotle argues that virtue and vice are “up to us and voluntary.” Readers have long struggled to make sense of Aristotle’s arguments in this chapter and to explain how they cohere with the rest of his ethical project. Among the most influential lines of complaint is that the argument of III.5 appears to contradict his emphasis elsewhere on the power of upbringing to shape character, beginning in childhood. Scholars have developed two main interpretive approaches to III.5, (...) which I label “libertarian” and “compatibilist.” I argue that neither approach succeeds in removing the appearance of contradiction. I develop an alternative interpretation that reveals the coherence of Aristotle’s commitments, showing that for him the voluntariness of character and the power of upbringing are in reality two sides of the same philosophical coin. Both are grounded in his fundamental idea that virtue and vice are acquired by practice. (shrink)

Contemporary philosophers and psychologists seek the roots of ethically sound forms of behavior, including altruism and a sense of fairness, in the basic structure of cooperative action. I argue that recent work on cooperation in both philosophy and psychology has been hampered by what I call “the mutualistic paradigm.” The mutualistic paradigm treats one kind of cooperative situation—what I call a “mutualistic situation”—as paradigmatic of cooperation in general. In mutualistic situations, such as the primeval stag hunt described by Brian Skyrms, (...) every partner in a cooperative action has to do his part in order for the action as a whole to succeed. But many familiar cooperative situations—for example, serving on an academic committee—do not have this structure. Contemporary philosophers and psychologists are right that thinking about cooperation can shed light on how and why ethically sound behavior happens in human beings. But the deep connections between ethics and cooperation only come into view once we have a richer conception of our capacities for cooperation than the mutualistic paradigm provides. (shrink)

The participation of adolescents in genetic research engenders unusual problems concerning the nature of their informed consent. In this study we analyze 70 consent documents collected from genetics investigators in the United States who conduct research with children and adolescents. We find that many consent documents do not reflect either the current or the developing ethical and legal standards for research with adolescents and that in many cases the documents are simply confusing or unclear. We make recommendations for change to (...) reflect more adequately the changing perspective concerning the autonomous decision-making capacity of adolescents. (shrink)

R. Jay Wallace argues in this book that moral accountability hinges on questions of fairness: When is it fair to hold people morally responsible for what they do? Would it be fair to do so even in a deterministic world? To answer these questions, we need to understand what we are doing when we hold people morally responsible, a stance that Wallace connects with a central class of moral sentiments, those of resentment, indignation, and guilt. To hold someone responsible, he (...) argues, is to be subject to these reactive emotions in one's dealings with that person. Developing this theme with unusual sophistication, he offers a new interpretation of the reactive emotions and traces their role in our practices of blame and moral sanction. With this account in place, Wallace advances a powerful and sustained argument against the common view that accountability requires freedom of will. Instead, he maintains, the fairness of holding people responsible depends on their rational competence: the power to grasp moral reasons and to control their behavior accordingly. He shows how these forms of rational competence are compatible with determinism. At the same time, giving serious consideration to incompatibilist concerns, Wallace develops a compelling diagnosis of the common assumption that freedom is necessary for responsibility. Rigorously argued, eminently readable, this book touches on issues of broad concern to philosophers, legal theorists, political scientists, and anyone with an interest in the nature and limits of responsibility. (shrink)

Reason and Value collects 15 new papers by leading contemporary philosophers on themes from the work of Joseph Raz. Raz has made major contributions in a wide range of areas, including jurisprudence, political philosophy, and the theory of practical reason; but all of his work displays a deep engagement with central themes in moral philosophy. The subtlety and power of Raz's reflections on ethical topics make his writings a fertile source for anyone working in this area. Especially significant are his (...) explorations of the connections between practical reason and the theory of value, which constitute a sustained and penetrating treatment of a set of issues at the very center of moral philosophy as it is practiced today. The contributors to the volume acknowledge the importance of Raz's contributions by engaging critically with his positions and offering independent perspectives on the topics that he has addressed. The volume aims both to honour Raz's accomplishments in the area of ethical theorizing, and to contribute to an enhanced appreciation of the significance of his work for the subject. (shrink)

A defence of the idea that there are sui generis duties of love: duties, that is, that we owe to people in virtue of standing in loving relationships with them. I contrast this non‐reductionist position with the widespread reductionist view that our duties to those we love all derive from more generic moral principles. The paper mounts a cumulative argument in favour of the non‐reductionist position, adducing a variety of considerations that together speak strongly in favour of adopting it. The (...) concluding section connects this debate with larger issues in moral theory concerning the general idea of obligation. (shrink)

The Moral Nexus develops and defends a new interpretation of morality—namely, as a set of requirements that connect agents normatively to other persons in a nexus of moral relations. According to this relational interpretation, moral demands are directed to other individuals, who have claims that the agent comply with these demands. Interpersonal morality, so conceived, is the domain of what we owe to each other, insofar as we are each persons with equal moral standing. The book offers an interpretative argument (...) for the relational approach. Specifically, it highlights neglected advantages of this way of understanding the moral domain; explores important theoretical and practical presuppositions of relational moral duties; and considers the normative implications of understanding morality in relational terms. The book features a novel defense of the relational approach to morality, which emphasizes the special significance that moral requirements have, both for agents who are deliberating about what to do and for those who stand to be affected by their actions. The book argues that relational moral requirements can be understood to link us to all individuals whose interests render them vulnerable to our agency, regardless of whether they stand in any prior relationship to us. It also offers fresh accounts of some of the moral phenomena that have seemed to resist treatment in relational terms, showing that the relational interpretation is a viable framework for understanding our specific moral obligations to other people. (shrink)

Responsibility and the Moral Sentiments offers an account of moral responsibility. It addresses the question: what are the forms of capacity or ability that render us morally accountable for the things we do? A traditional answer has it that the conditions of moral responsibility include freedom of the will, where this in turn involves the availability of robust alternative possibilities. I reject this answer, arguing that the conditions of moral responsibility do not include any condition of alternative possibilities. In the (...) terms that have become familiar, the book thus defends a compatibilist account of moral responsibility. (shrink)

The View from Here is a study of our must fundamental attitudes toward the past. The book explores the dynamics of affirmation and regret, tracing the connections of each to our ongoing attachments. The focus is on situations in which our attachments commit us to affirming events or decisions that we know to have been unfortunate or regrettable.

This paper addresses some connections between conceptions of the will and the theory of practical reason. The first two sections argue against the idea that volitional commitments should be understood along the lines of endorsement of normative principles. A normative account of volition cannot make sense of akrasia, and it obscures an important difference between belief and intention. Sections three and four draw on the non-normative conception of the will in an account of instrumental rationality. The central problem is to (...) explain the grip of instrumental requirements even in cases in which agents do not fully endorse the ends they are pursuing. The solution I propose appeals to coherence constraints on the beliefs that condition the distinctive volitional stance of intention. (shrink)

Normativity and the Will collects fourteen important papers on moral psychology and practical reason by R. Jay Wallace, one of the leading philosophers currently working in these areas. The papers explore the interpenetration of normative and psychological issues in a series of debates that lie at the heart of moral philosophy. Themes that are addressed include reason, desire, and the will; responsibility, identification, and emotion; and the relation between morality and other normative domains. Wallace's treatments of these topics are at (...) once sophisticated and engaging. Taken together, they constitute an advertisement for a distinctive way of pursuing issues in moral psychology and the theory of practical reason, and they articulate and defend a unified framework for thinking about those issues. The volume also features a helpful new introduction. (shrink)

European Journal of Philosophy, EarlyView.

A defence of the idea that there are sui generis duties of love: duties, that is, that we owe to people in virtue of standing in loving relationships with them. I contrast this non-reductionist position with the widespread reductionist view that our duties to those we love all derive from more generic moral principles. The paper mounts a cumulative argument in favour of the non-reductionist position, adducing a variety of considerations that together speak strongly in favour of adopting it. The (...) concluding section connects this debate with larger issues in moral theory concerning the general idea of obligation. (shrink)

Practical reason is the general human capacity for resolving, through reflection, the question of what one is to do. Deliberation of this kind is practical in at least two senses. First, it is practical in its subject matter, insofar as it is concerned with action. But it is also practical in its consequences or its issue, insofar as reflection about action itself directly moves people to act. Our capacity for deliberative self-determination raises two sets of philosophical problems. First, there are (...) questions about how deliberation can succeed in being practical in its issue. What do we need to assume — both about agents and about the processes of reasoning they engage in — to make sense of the fact that deliberative reflection can directly give rise to action? Can we do justice to this dimension of practical reason while preserving the idea that practical deliberation is genuinely a form of reasoning? Second, there are large issues concerning the content of the standards that are brought to bear in practical reasoning. Which norms for the assessment of action are binding on us as agents? Do these norms provide resources for critical reflection about our ends, or are they exclusively instrumental? Under what conditions do moral norms yield valid standards for reasoning about action? The first set of issues is addressed in sections 1-3 of the present article, while sections 4-5 cover the second set of issues. (shrink)

Rational agency may be thought of as intentional activity that is guided by the agent's conception of what they have reason to do. The paper identifies and assesses three approaches to this phenomenon, which I call internalism, meta-internalism, and volitionalism. Internalism accounts for rational motivation by appeal to substantive desires of the agent's that are conceived as merely given; I argue that it fails to do full justice to the phenomenon of guidance by one's conception of one's reasons. Meta-internalism explains (...) this phenomenon by postulating higher-order dispositions, consitutive of (rational) agency itself, which causally interact with the agent's normative beliefs to produce corresponding motivations to action. I show that meta-internalism comes to grief over cases of akrasia, insofar as it leaves no room for the capacity for rational guidance when agents voluntarily act at variance with their judgments about what they have reason to do. Volitionalism, I contend, improves on both internalism and meta-internalism. Its distinctive feature is the postulation of a kind of motivation that is directly subject to the agent's control, and independent of the dispositions and desires to which the agent is passively subject. (shrink)